Periodontal Therapy In Smokers Research Articles

Salivary cytokine expression after non-surgical periodontal therapy in smokers: 12-month follow-up.

Diverse smoking trajectories may influence cytokine expression after non-surgical periodontal therapy and supportive periodontal care. Thus, we aimed to describe cytokine profiles in periodontal healing after periodontal therapy in smokers. A smoking cessation program and non-surgical periodontal therapy were offered to 80 smokers with periodontitis. Smoking trajectories (quitters/light, moderate, heavy) were observed. The association of salivary interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, interferon-gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α) with smoking trajectories and periodontal outcomes was determined using mixed-effects linear regression. Among quitters/light smokers, IL-1β was associated with an increase in mean periodontal pocket depth (PPD) and mean clinical attachment level (CAL). IL-6 was associated with a decrease in mean PPD and CAL in heavy smokers, whereas IL-8 was associated with a decrease in PPD among moderate smokers. TNFα was associated with a reduction in mean PPD and CAL among quitters/light smokers, while among moderate smokers, TNFα was associated with an increase in mean PPD and CAL. IL-12 and IL-13 were associated with a decrease in mean PPD in moderate smokers. Our findings suggest that distinctive smoking exposures induce differential cytokine expression, which, in turn, seems to influence periodontal repair.

Clinical and bacterial outcomes of photodynamic therapy in the treatment of chronic necrotizing ulcerative periodontitis

AimTo assess the clinical periodontal and microbiological parameters in patients having chronic necrotizing ulcerative periodontitis (NUP) after the administration of adjunctive photodynamic therapy and non-surgical periodontal therapy in smokers, mal-nutrition and HIV positive individuals. Materials and MethodsA total of 30 individuals with NUP were selected for the present clinical trial, where both Group I and Group II had equal number of patients, respectively (15 each). The groups were divided on the basis of provision of treatment where patients in Group I underwent scaling and root planing (SRP). Furthermore, Group II patients were subjected to adjunctive phtotodynamic therapy and SRP (aPDT + SRP). Full mouth plaque scores (fmpS), full mouth bleeding on probing (fmBOP), periodontal pocket depth (PPD) and clinical attachment levels (CAL) were the clinical periodontal parameters that were carefully evaluated. Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Tannerella forsythia (Tf) were the bacteria species which were evaluated. The assessments were done at baseline, three (3) months and six (6) months, respectively. ResultsAll periodontal parameters including fmpS, fmBOP, PPD and CAL significantly improved in both Group I and Group II, respectively. Group II patients subjected to aPDT + SRP reported higher reduction in mean PPD in comparison to Group I patients at follow up (p < 0.05). At follow-up, similar results were also reported for CAL gain where Group II (aPDT +SRP) patients reported higher CAL gain in comparison to patients who underwent SRP only (p < 0.05). From baseline to follow-up, all the bacterial levels exhibited reduction in both study groups i.e Group I (SRP) and Group II (aPDT + SRP), respectively (p < 0.05). However, Group II patients prominent reduction in the counts of Aa and Tf at the three-month interval, whereas Aa seem to reduce in HIV and smoking individuals at the six-month interval. Moreover, the levels of Pg and Tf significantly reduced at 3 months and only Aa at 6 months in patients with mal-nutrition, respectively (p < 0.05). ConclusionThe use of photodynamic treatment as an adjunct to scaling and root planing enhanced clinical periodontal results and reduced bacterial content in patients having NUP.

PR451: Non‐surgical periodontal therapy in smokers: clinical and histological assessments

PR451: Non‐surgical periodontal therapy in smokers: clinical and histological assessments

The effect of long‐term aspirin intake on the outcome of non‐surgical periodontal therapy in smokers: a double‐blind, randomized pilot study

The objective of this parallel, double-blind, randomized pilot study was to determine the effect of a daily dose of 325mg of aspirin (ASA) on the clinical outcomes of scaling and root planing in a selected group of adult smokers. The response to periodontal therapy is inferior among smokers compared to non-smokers. Long-term intake of ASA has been shown to exert a positive impact on reducing both the prevalence and severity of periodontitis, among high-risk groups of subjects such as heavy smokers and diabetics. It is reasonable to assume that systemic administration of ASA in conjunction with reduction of the bacterial load by scaling and root planing may improve and prolong the benefits of periodontal therapy. To date, only few prospective interventional clinical studies have specifically addressed the periodontal needs of smokers. The study includes 24 smokers. The following clinical parameters were measured preoperatively and at 3, 6, 9 and 12mo postoperatively: (i) gingival index; (ii) plaque index; (iii) probing depth; (iii) probing attachment level; (iv) gingival recession; and (v) bleeding scores. Study subjects received scaling and root planing over several visits and were randomly assigned into two equal groups; a control group (C), which received a placebo and a test group (T), which took a daily dose of 325mg ASA. No additional therapy was provided over the 1year observation period. There were more statistically significant differences (p<0.05; one- tailed) between pretest and posttest scores in the T group than in the C group. Mean percent increase in sites with probing depth 1-3mm (T: 8.78; C: 7.21); mean percent reduction in sites with probing depth 4-6mm (T: -7.25; C: -5.09 not statistically significant, NS); mean percent reduction in sites with probing depth ≥7mm (T: -1.42; C: -02.09); mean percent reduction in sites with probing attachment level 3-4mm (T: -3.63; C: 0.48NS); mean percent reduction in sites with bleeding on probing (T: -12.37; C: -2.59NS) (p<0.05, NS). Daily intake of 325mg of ASA following scaling and root planing improved treatment outcomes in smokers, without an increase in gingival bleeding tendency. ASA promoted a higher incidence of shallow pockets and more gain in attachment level.

A Systematic Review of Clinical Efficacy of Adjunctive Antibiotics in the Treatment of Smokers With Periodontitis

The aim of this study is to systematically review the evidence of the efficacy of adjunctive antibiotic therapy to periodontal therapy in smokers with periodontitis. A search was conducted for randomized clinical trials (RCTs) with durations ≥6 months that compared periodontal therapy with and without adjunctive antibiotics for the treatment of periodontitis in smokers. Data sources primarily included PubMed with MeSH terms and free text as well as EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Clinical Trials. In addition, a hand search of selected periodontal journals, bibliographies, and review articles was conducted. Independent reviewers were assigned to make independent searches and quality assessments (MA and DB) of the included studies, and disagreements were resolved by discussion. Five RCTs were selected for quantitative and qualitative assessments. Little evidence was found that supported the use of antibiotic therapy in conjunction with surgical periodontal therapy in smokers. With respect to non-surgical therapy, consistent improvements in clinical attachment level (CAL) gain and probing depth (PD) reduction was reported after the use of a 250-mg azithromycin tablet in one study. Adjunctive doxycycline gel and minocycline microspheres statistically improved CAL gain (in one RCT) and PD reduction (in one RCT), respectively. However, the risk of bias in all studies was estimated as high. Also, inadequate and inconsistent data precluded performing meta-analyses. The present systematic review concludes that the evidence for an additional benefit of adjunctive antibiotic therapy in smokers with chronic periodontitis is insufficient and inconclusive. Additional well-designed RCTs are required to assess the effect of antibiotics in conjunction with periodontal treatments in smokers.

No evidence to support the use of low-dose doxycycline as an adjunct to nonsurgical therapy in smokers

This was a randomised, placebo-controlled trial with 6 months of follow-up. Patients received nonsurgical periodontal therapy and 3 months of the test treatment (low-dose doxycycline; LDD) or control (inactive identical placebo). The primary outcome was the change in the clinical attachment level (CAL) recorded from the cemento-enamel junction to the base of the probing pocket using a graduated UNC-15 probe (Hu Friedy, Chicago, Illinois, USA). Secondary outcomes included pocket depth, gingival recession and bleeding on probing recorded at six sites per tooth with the manual probe and ICTP (terminal carboxytelopeptide of type 1 collagen). The velocity of change was statistically significantly greater for the test group for CAL [-0.19 mm/ month; 95% confidence interval (CI), -0.34- -0.04; P 0.012] and probing depth (0.30 mm/ month; 95% CI, -0.42- -0.17; P 0.001). No differences were observed, however, for absolute change in clinical or biochemical markers at 6 months. Nonsurgical periodontal therapy in smokers can produce a substantial improvement in periodontal health but there is no evidence to support the use of LDD as an adjunct to their nonsurgical therapy. Quitting tobacco use continues to be of fundamental importance in improving the periodontal health of these individuals.

A randomized‐controlled trial of low‐dose doxycycline for periodontitis in smokers

Tobacco use reduces the effect of non-surgical periodontal therapy. Host-modulation with low-dose doxycycline (LDD) might favour repair and promote an improved treatment response. The aim of this study was to investigate the effect of LDD in smokers on non-surgical periodontal therapy. This was a parallel arm, randomized, identical placebo-controlled trial with masking of examiner, care-giver, participant and statistician and 6 months of follow-up. Patients received non-surgical therapy and 3 months of test or control drug. Statistical analysis used both conventional methods and multilevel modelling. Eighteen control and 16 test patients completed the study. The velocity of change was statistically greater for the test group for clinical attachment level -0.19 mm/month (95% CI=-0.34, 0.04; p=0.012) and probing depth 0.30 mm/month (95% CI=-0.42, -0.17; p<0.001). However, no differences were observed for absolute change in clinical or biochemical markers at 6 months. This study does not provide evidence of a benefit of using LDD as an adjunct to non-surgical periodontal therapy in smokers.

Clinical Response of Azithromycin as an Adjunct to Non‐Surgical Periodontal Therapy in Smokers

Antibiotic therapy can be used in very specific periodontal treatment situations such as in refractory cases of periodontal disease found to be more prevalent in smokers. This study was designed to determine the efficacy of azithromycin (AZM) when combined with scaling and root planing (SRP) for the treatment of moderate to severe chronic periodontitis in smokers. Thirty-one subjects were enrolled into a 6-month randomized, single-masked trial to evaluate clinical, microbial (using benzoyl- DL-arginine naphthylamine [BANA] assay), and gingival crevicular fluid (GCF) pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) levels in response to SRP alone or SRP + AZM. At baseline, patients who smoked > or =1 pack per day of cigarettes who presented with at least five sites with probing depths (PD) of > or =5 mm with bleeding on probing (BOP) were randomized into the test or control groups. At baseline and 3 and 6 months, clinical measurements (probing depth [PD], clinical attachment loss [CAL], and bleeding on probing [BOP]) were performed. GCF bone marker assessment (Ctelopeptide [ICTP] as well as BANA test analyses) were performed at baseline, 14 days, and 3 and 6 months. The results demonstrated that both groups displayed clinical improvements in PD and CAL that were sustained for 6 months. Using a subject-based analysis, patients treated with SRP + AZM showed enhanced reductions in PD and gains in CAL at moderate (4 to 6 mm) and deep sites (>6 mm) (P <0.05). Furthermore, SRP + AZM resulted in greater reductions in BANA levels compared to SRP alone (P <0.05) while rebounds in BANA levels were noted in control group at the 6-month evaluation. No statistically significant differences between groups on mean BOP and ICTP levels during the course of the study were noted. The utilization of AZM in combination with SRP improves the efficacy of non-surgical periodontal therapy in reducing probing depth and improving attachment levels in smokers with moderate to advanced attachment loss.

Effect of periodontal therapy in smokers and non-smokers with advanced periodontal disease; results after maintenance therapy for a minimum of five years

Effect of periodontal therapy in smokers and non-smokers with advanced periodontal disease; results after maintenance therapy for a minimum of five years

Locally delivered minocycline in adjunctive to scaling and root planing (SRP) is more effective in mean pocket depth reduction than SRP alone in treating smokers with chronic periodontitis

Paquette D, Oringer R, Lessem J, Offenbacher S, Genco R, Persson GR, Santucci EA, Williams RC. Locally delivered minocycline microspheres for the treatment of periodontitis in smokers. J Clin Periodontol 2003;30(9):787-94. 1b Is minocycline microspheres in conjunction with scaling & root planing (SRP) more effective in periodontal therapy in smokers than SRP alone? Information not available Randomized single-blinded clinical trial

Effect of periodontal therapy in smokers and non-smokers with advanced periodontal disease: results after maintenance therapy for a minimum of 5 years.

Longitudinal clinical studies show smoking is a risk factor for periodontal disease progression. It has also been documented that smoking impairs healing after periodontal therapy. However, the longitudinal effect of smoking on treatment results in patients who undergo long-term maintenance therapy has not been extensively investigated. This study clinically and radiographically compared smoking and non-smoking patients who had been treated for advanced periodontal disease and who received maintenance therapy for a minimum of 5 years. Twenty-nine patients were selected over a 6-month period when they presented for a regularly scheduled visit in a private office. Patients were selected on the basis of initially having lost 50% of bone support on 50% of their teeth; had received follow-up therapy for at least 5 years; were compliant at 75% of the appointments; and had plaque scores < 20% in 75% of the visits. All patients had received non-surgical and surgical therapy as required for pocket elimination. Fourteen were active smokers during the entire maintenance period. Clinical measurements of probing depths and presence of plaque and gingivitis and a new set of standardized radiographs were taken. Smokers had higher mean radiographic bone loss values prior to treatment (7.52 +/- 1.39 versus 6.65 +/- 1.39) and at the final examination (7.32 +/- 1.42 versus 6.29 +/- 1.29) mean radiographic bone loss as well as initial, immediate post-therapy, and final percent of pockets > or = 6 mm (1.42% +/- 1.87% versus 0.60% +/- 1.11%). Differences were not statistically significant. Over 5 to 8 years, seven sites in four non-smokers and 11 sites in six smokers exhibited radiographic bone loss > or = 2 mm. One tooth in a non-smoker and three teeth in two smokers were lost. In a logistic regression analysis, smoking increased the odds ratio 10.7 times of having > or = 1 site with bone loss > or = 2 mm. The present study on a small group of patients treated for advanced periodontal disease and well maintained over 5 to 8 years showed no statistically significant differences between smokers and non-smokers in clinical probing depth and radiographic bone loss measurements.

The clinical and microbiological effects of non-surgical periodontal therapy in smokers and non-smokers.

28 patients, 13 smokers and 15 non-smokers with untreated advanced periodontal disease, were subjected to a series of oral hygiene instructions and treated with non-surgical periodontal therapy. Baseline values regarding clinical data did not differ significantly between the groups. 6 months following therapy the full-mouth bleeding score among smokers was 36.5% as compared to 22.7% for non-smokers (p < 0.05). Probing depth was reduced by 1.9 mm for smokers and by 2.5 mm for non-smokers. This difference was statistically significant (p < 0.05). The level of P. gingivalis and P. intermedia/nigrescens was reduced in both groups as compared to baseline. A. actinonmycetemcomitans, however demonstrated a slight increase in mean values at 6 months. This was especially notable for smokers in which A. actinomycetemcomitans were more difficult to eradicate. Conclusively, the microbiological response found in this study seems to be in conformity with the clinical response with little influence of the smoking habits.